对胆囊息肉样病变外科处理的思考

摘要

胆囊息肉的检出率越来越高.为了预防癌变或者避免漏诊胆囊癌,目前主流的做法是对大于1 cm的息肉行胆囊切除术,而保胆手术则是把息肉大于0.5 cm作为手术指征.这2个手术指征未必合理,因为按照该标准切除的胆囊息肉,大部分是不会癌变的胆固醇息肉.过早干预意味着过度医疗.同时,手术有出现严重并发症的风险.对胆固醇息肉患者而言,手术意味着额外的风险与创伤,得不偿失.因此,应该从严掌握胆囊息肉的手术指征,仅对胆囊息肉的高危人群做出手术选择.%The detection rate of polypoid lesions of gallbladder has increased.In order to prevent malignancy or to avoid missed diagnosis of gallbladder carcinoma,the mainstream of the current practice is recommended for cholecystectomy if polyps are larger than 1 cm,and polyps larger than 0.5 cm is the indication for gallbladder-preserving operation.But the recommendations mentioned above are not quite reasonable,because most of polyps removed are the cholesterol ones which rarely become malignant.Besides,early intervention may lead to over-treatment and high risk of serious complications after surgery.Thus,surgery may bring additional trauma and risks to patients with cholesterol polyps of the gallbladder.Taken together,we should strictly determine the operation indications for gallbladder polyps and surgery may be appropriate for high-risk patients only.